Health Information Exchange September 14, 2018 Gijs van Oort, PHD CEO HASA Emily Hartmann Executive Director PHIX

Agenda What are health information exchanges (HIEs)? Overview of two HIEs in Texas HASA – Healthcare Access San Antonio PHIX - Paso del Norte Health Information Exchange How do I choose the right network?

What are health information exchanges (HIEs)?

One Big Problem: Unreliable and inefficient health information sharing Lack of medication management Repeated lab and imaging studies Preventable medical errors Poor care coordination

Centralized hubs facilitate data exchange Hospital Primary Care Clinic FQHC Lab Hospital Health Information Exchange (HIE) Repository Specialist ED Urgent Care Primary Care Clinic Specialist FQHC = Federally Qualified Health Center; HIE = Health Information Exchange, ED = Emergency Department

HIEs have the same goal but different approaches Common goal: Improve health by ensuring the right information is in the right place at the right time. HIEs can be structured differently: Governance Legal Privacy and Security Financial Patient Consent Functionality

National effort to connect HIEs Source: SHIEC. http://strategichie.com/initiatives/pcdh/.

Future: Single on-ramp for interoperability Trusted Exchange Framework and Common Agreement There is no “magic bullet” for nationwide interoperability The goal is to build networks that connect Choose the right network(s) for your organization Network serves as a single on-ramp for interoperability

Community Health Information Exchange Benefits and Value HASA is community Health Information Exchange in full production since 2010 and with data contributors since 2012. Gijs van Oort, PhD CEO 210.918.1357 gvanoort@hasatx.org

Growing Demand for Health Care Federal Budget for HHSC is decreasing Source: UTSA Demographics Center Source: TX Medicaid and CHIP in Perspective - 11th Edition Federal Budget for HHSC is decreasing

Increased Demand with Same or Lower Reimbursement Rationing of Care or Greater efficiency in care delivery Triple Aim Better care Better health Reasonable cost Payment Reform (From Fee for Service to Pay for Performance) Bundled payment MIPS/APM Patient Centered Medical Homes Readmissions penalties Need actionable, real-time, patient information HIE

HASA Capabilities Aggregated patient lookup Data push into customer systems (CCD, ADT) Real-time, clinical reporting for quality, utilization, public health, care coordination Electronic referral system Alerts and discharge notification Connection to TX HIEs and national HIEs Connectivity to DoD & VA (in development)

Community Health/ Mental Health HASA HIE Coverage Area to Date Nonprofit, with broad community participation Physicians 1703 Hospitals 43 Waco Region San Angelo Region Community Health/ Mental Health 3 HASA’s initial coverage area spanned the greater San Antonio region, comprising 22 counties. The Corpus region currently uses HASA services as does the North Texas region. (this slide needs updated map…) FQHC 7

HASA discussions with Western Plains hospitals

HASA HIE data exchange HASA’s initial coverage area spanned the greater San Antonio region, comprising 22 counties. The Corpus region currently uses HASA services as does the North Texas region. (this slide needs updated map…)

HASA Landing Dashboard HASA Data Elements: Demographics Encounters Lab Radiology Discharge Immunizations (some) Medications (some)

From: Sugumar, Sophia (CMS/CCSQ) [mailto:Sophia. Sugumar@cms. hhs From: Sugumar, Sophia (CMS/CCSQ) [mailto:Sophia.Sugumar@cms.hhs.gov] Sent: Wednesday, March 22, 2017 5:08 PM To: Andrea Espinosa <aespinosa@HASATX.ORG>; Vince Fonseca <vfonseca@HASATX.ORG>; Phil Beckett <pbeckett@HASATX.ORG> Subject: Action Required: 2017 MIPS Qualified Registry Posting DRAFT: Healthcare Access San Antonio Importance: High   Congratulations! You’ve been approved to participate in the Merit-Based Incentive Program (MIPS) for 2017 as a qualified registry.

Social Determinants of Health Target 2018 Develop an intake platform for CMS five categories for personal risk: Food insecurity Utility needs Housing instability Interpersonal violence Transportation needs Implement intake capability for geographic risk: Categorize zip code and census tract by vulnerability status Create holistic patient view for providers to include: Clinical risk Social/personal risk Geographic risk

HASA Virtual Health Record – Social Risks

HASA VHR – Geospatial Risks

HIE Collaboration during Harvey GHH and HASA decided to collaborate by providing temporary access to each other’ HIEs as most of the affected area was accessible through one or the other: GHH supporting evacuees in Houston HASA supporting coastal residents cared for outside the region HASA reached out to ICC for assistance in Austin shelter HASA established a connection with Louisiana HIE as evacuees reached the Dallas shelter HIETexas was reactivated for an additional 30 days

Emily Hartmann Executive Director

Non-profit based in El Paso region Mission to improve health through collaboration and data technology. PHIX Board includes representatives from each of PHIX’s major partners. Changed name in 2017 to better reflect broader region.

Provide centralized community health records HIE = health information exchange

Connected to VA and Dept. of Defense Nationally User Story: Active duty soldier and his family recently moved to Texas from Washington, DC. When his child visited a community specialist for a chronic health need, the specialist used PHIX to review the child’s full care record from the Dept. of Defense in Washington, DC. As a result, they avoided repeating several lab and imaging tests.

Value of PHIX: Stories from our users Improved safety Hospitalist planned to perform a cardiac catheterization for their patient. Prior to the procedure, they queried PHIX and found that a cardiac catheterization had been performed at another hospital. As a result, the patient received better care and avoided an unnecessary procedure. Improved efficiency Primary care physician queried PHIX before doing a stroke assessment for their patient. They found results from a stroke assessment performed the previous week at a hospital. As a result, the patient avoided several repeated imaging and lab tests. Improved quality Emergency Medicine physician had a patient in cardiac arrest who could not speak to her care history. Through PHIX, they found information on her cardiac conditions and medications from other providers. Based on this additional information, her treatment was adjusted.

Recognized for innovation and collaboration in public health National Association of County and City Health Officials (NACCHO) selected the City of El Paso Department of Public Health as a Promising Practice for its Paso del Norte Electronic Network for Linkage to Preventive Health Services in 2018. “This project offers a holistic approach to patients using a medical data hub to evaluate a person’s needs. We are able to use the system by cross referencing our clients’ information to make sure if they need further services such as cancer screenings or vaccinations, then they are either provided the care or are directed to the proper venues.” Robert Resendes, Public Health Director

Data exchange partners Hospitals (6) Outpatient Clinics (6) Veterans Administration* Department of Defense* Texas Tech University Health Sciences Center of El Paso Local Mental Health Authority Federally Qualified Health Centers (3) City of El Paso Department of Public Health PHIX is actively recruiting partners throughout west Texas and southern New Mexico. *National connections through the eHealth Exchange.

Support and engage small physician practices The physician community in our region consists primarily of small practices with one to four physicians. PHIX supports practices in navigating complex federal regulations, quality reporting requirements, and privacy and security standards. PHIX has an internal technical team to develop HIE interfaces with small practices rather than relying on third-party vendors. HIE = health information exchange

PHIX Structure Patient Consent Governance Generally, patients must opt out to prevent data from being shared. There are exceptions. Patients at mental health and substance abuse facilities must opt in. Governance PHIX Board of Directors includes representatives from PHIX’s partners. PHIX Committees provide feedback on how PHIX should operate and grow. Privacy and Security Committee Physician Advisory Committee Strategic Planning Committee Governance Committee

Exploring additional services to benefit PHIX’s partners Real-time notifications to care managers when patients are admitted, discharged, and transferred Image exchange Connectivity to other HIEs

How do I choose the right network?

Choose the right front door for your community Choose the “front door” to interoperability that is the best fit for your community. Technology: What functionality do we need to meet our goals today and in the future? Network: Who do we need in our data sharing network locally? Nationally? Cost: What type of investment would be required? Governance: Who is making decisions on how data is managed? Legal: What can the data be used for? Privacy and Security: What controls are in place? Who is making sure it runs properly? Consent: Would our community prefer an opt-in or opt-out patient consent model? Your front door will serve as a connection point across Texas and nationally. HIEs in Texas are committed to working together.

Thank you Emily Hartmann, Executive Director, PHIX ehartmann@phixnetwork.org Office: 915.242.0674 |Cell: 217.741.5081 Gijs van Oort, PhD, CEO, HASA gvanoort@hasatx.org 210.918.1357